Bisphosphonate Use and the Risk of Undergoing Total Knee Arthroplasty in Osteoporotic Patients with Osteoarthritis

Fu, Shau-Huai; Wang, Chenyu; Yang, Rong‐Sen; Wu, Fe-Lin Lin; Hsiao, Fei‐Yuan

doi:10.2106/jbjs.16.00385

Cited by 45 publications

(42 citation statements)

References 28 publications

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“…(48,49) Our study indicates that a synergism between OA and OP could promote the progression of OA when OA has already occurred. Moreover, the current study supported some studies on the treatment of OP and OA focusing on biomechanics, (50,51) and reasonably suggests that treatment with bone metabolism agents (ie, bisphosphonates or estrogen) could reverse the dominance of resorption over formation in subchondral bone remodeling, thus exerting a beneficial effect on microstructure and biomechanical properties, which may mitigate the OA development in patients with OP-OA.…”

Section: Discussionsupporting

confidence: 83%

Articular Cartilage Degradation and Aberrant Subchondral Bone Remodeling in Patients with Osteoarthritis and Osteoporosis

Chu

Liu

et al. 2019

Journal of Bone and Mineral Research

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Osteoarthritis (OA) and osteoporosis (OP) are two skeletal disorders associated with joint structures. Occasionally, OA and OP occur in the same patient. However, the effect of OP changes on OA progression in patients with osteoporotic OA (OP‐OA) has not been reported, especially the potential association between subchondral bone and articular cartilage. Thus we investigated the alterations in the microstructure, biomechanical properties, and remodeling of subchondral bone as well as their association with cartilage damage in the hip joint of patients with OP‐OA. Thirty‐nine femoral head specimens were obtained from patients who underwent total hip arthroplasty (OA group, n = 19; OP‐OA group, n = 20), and healthy specimens from cadaver donors were used (control group, n = 10). The microstructure and biomechanical properties of subchondral bone were evaluated by micro–computed tomography and micro–finite‐element analysis. Histology, histomorphometric measurements, and immunohistochemistry were used to assess subchondral bone remodeling and cartilage damage. Linear regression analysis was performed to elucidate the relationship between subchondral bone and articular cartilage. In the subchondral bone of the OP‐OA group, compared with that of the OA group, aberrant bone remodeling leads to an inferior microstructure and worsening biomechanical properties, potentially affecting transmission of loading stress from the cartilage to the subchondral bone, and then resulting in accelerated OA progression in patients with OP‐OA. The results indicate that changes in subchondral bone could affect OA development and the improvement in subchondral bone with bone‐metabolism agents may help mitigate OA progression when OP and OA coexist in the same patients. © 2019 American Society for Bone and Mineral Research.

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Section: Discussionsupporting

confidence: 83%

Articular Cartilage Degradation and Aberrant Subchondral Bone Remodeling in Patients with Osteoarthritis and Osteoporosis

Chu

Liu

et al. 2019

Journal of Bone and Mineral Research

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“…In recent studies, the presence of BMLs has been associated with knee pain and predicted cartilage loss in patients with established KOA [36][37][38] . Antiresorptive drugs (e.g., bisphosphonate) were found to reduce the size of BMLs and the risk for total knee arthroplasty in KOA patients 39,40 . In early KOA, lower bone mineral density and higher levels of some bone markers were associated with the presence of BMLs 16 .…”

Section: Discussionmentioning

confidence: 99%

Relationship between magnetic resonance imaging lesions and knee symptoms in early knee osteoarthritis: A cross-sectional Japanese population study

Ota

Sasaki

et al. 2020

Preprint

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Background: The prevalence of minute structural abnormalities in early knee osteoarthritis (KOA) and their association with knee symptoms remains unclear. We investigated the prevalence of abnormalities detected by magnetic resonance imaging (MRI) and their relation to knee symptoms in women without radiographic evidence of KOA.Methods: This cross-sectional cohort study in a Japanese population included 261 women without radiographic evidence of KOA, which was defined as a Kellgren‒Lawrence grade < 2. All participants underwent T2-weighted fat-suppressed MRI of their right knee. Structural abnormalities (cartilage damage, bone marrow lesions [BMLs], subchondral cysts, bone attrition, osteophytes, meniscal lesions, and synovitis) were scored according to the Whole-Organ MRI Scoring method. Knee symptoms were evaluated by the Knee injury and Osteoarthritis and Outcome Score (KOOS). Participants were divided into early KOA and non-KOA groups based on early KOA classification criteria. Logistic regression analysis was performed to evaluate the relationship between MRI abnormalities and knee symptoms.Results: Cartilage damage were the most common abnormality (53%), followed by osteophytes (43%), and BMLs (33%). The prevalence of BMLs (47%), meniscal lesions (26%), and synovitis (37%) was higher in early KOA than in non-KOA. On logistic regression analysis, synovitis (odds ratio [OR] = 1.901, P = 0.013) and meniscal lesions (OR = 1.410, P = 0.045) were positively associated with the presence of early KOA.Conclusions: The prevalence of BMLs, meniscal lesions, and synovitis was higher in symptomatic knees. Synovitis was most strongly associated with knee pain and might be a therapeutic target in patients with early KOA.

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“…After controlling for potential confounders, patients starting bisphosphates were 24% less likely to have a TKR over a 3-year period, compared to similar patients who did not start a bisphosphonate 20 . Fu et al utilized a large national insurance database in Taiwan to ask a similar question 21 . These investigators evaluated rates of TKR in osteoporotic patients with knee OA, comparing rates between those who did and did not start a bisphosphonate.…”

Section: Therapies For Oamentioning

confidence: 99%

Osteoarthritis year in review 2018: clinical

Mandl

2019

Osteoarthritis and Cartilage

258

162

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Osteoarthritis (OA) is the most common joint disease in the world, with an age-associated increase in both incidence and prevalence. Clinical and epidemiologic research is crucial to better understand risk factors for disease, find the best treatments for symptoms, and identify therapies to slow down or even prevent disease progression. This paper is based on a systematic review of the osteoarthritis literature published in English between 2017/05/01 and 2018/04/25, with a focus on papers which have the potential to improve patient care, or which suggest novel areas for future research.

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Bisphosphonate Use and the Risk of Undergoing Total Knee Arthroplasty in Osteoporotic Patients with Osteoarthritis

Abstract: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

Cited by 45 publications

References 28 publications

Articular Cartilage Degradation and Aberrant Subchondral Bone Remodeling in Patients with Osteoarthritis and Osteoporosis

Articular Cartilage Degradation and Aberrant Subchondral Bone Remodeling in Patients with Osteoarthritis and Osteoporosis

Relationship between magnetic resonance imaging lesions and knee symptoms in early knee osteoarthritis: A cross-sectional Japanese population study

Osteoarthritis year in review 2018: clinical

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